A Case of Tacrolimus-Induced Posterior Reversible Encephalopathy Syndrome Initially Presenting as a Bilateral Optic...

To report a case of asymmetric bilateral optic neuropathy in a patient receiving tacrolimus for immunosuppression after kidney transplantation with subsequent stroke-like symptoms of posterior reversible encephalopathy syndrome (PRES).

Case report. In a 54-year-old Hispanic male receiving tacrolimus after orthotropic kidney transplantation, serial ophthalmologic examinations, laboratory studies, and imaging were performed.

The patient had deterioration of vision in the left eye with subclinical optic neuropathy in the right eye, with clinical features resembling ischemic optic neuropathy. Additionally, he developed a change in mental state with weakness of extremities. After the cessation of tacrolimus, the visual loss remained but the other neurologic symptoms resolved.

Tacrolimus may be associated with optic neuropathy and PRES at the initial presentation to an ophthalmologist.